Raised intracranial Pressure

Question 1

DDx

Answer 1

Idiopathic intracranial hypertension
Space-occupying lesion 
Haemorrhage 
Intracranial venous thrombosis 
Malignant hypertension

Question 2

Investigations

What you would see on CT/MRI that would indicate raised ICP?

What might a LP indicate?

Answer 2

CT/MRI - may show small ventricles

LP - opening pressure would indicate raised pressure

Question 3

Signs

Answer 3

Listless
Irritable 
Drowsy 
Headache 
Diplopia 
Vomiting 
Tense fontanelle 
Reduced consciousness 
using GCS

Question 4

What do you look for if they are unconscious? - 2

What could indicate imminent coning of the brain?

Answer 4

Look for pupil changes (ipsilateral dilatation)
Abnormal posturing (decorticate/decerebrate)
Papilloedema
Hydrocephalus

Cushing’s triad (slow pulse, raised BP and breathing pattern abnormalities) which warns of imminent coning

Question 5

Management

Approach
What to prevent?
When to do LP?
What to do if it severe?

Answer 5

ABCDE

To prevent ischaemia
Once CT is obtained and child is intubated

Take to ITU to monitor ICP and cerebral perfusion pressure

Question 6

Management

What should be done with child straight away?

What can be given to reduce the pressure in the eyes and ICP?

What else can be done conservatively to reduce ICP?

What should be monitored?

Where should the child be sent to for further care?

Answer 6

Intubation

Mannitol IVI over 30 minutes
Dexamethasone IV
Diuresis

Fluid restriction avoiding hypovolaemia

Pulse BP and continuously

Neurosurgical centre